Reflux In Babies

Overview

Reflux is when the contents of the stomach come back up into the food pipe or mouth. In babies, this often looks like bringing up milk, also called 'spitting up'. It happens because the muscle at the top of the stomach is not fully mature, so milk can easily flow back up.

Yes. Reflux is very common in babies, especially in the first few months of life. Around half of all babies under 3 months have some degree of reflux.

It affects babies, most often between birth and 6 months. Premature babies are more likely to have reflux. Most babies outgrow it by the time they are 12 months old.

Symptoms

Common symptoms

• Spitting up or bringing up milk after feedings
• Hiccups or coughing after feeding
• Being unsettled or fussy during or after feeds
• Wet burps or milk dribbling out
• Arching their back during or after feeding

Symptoms in children

• Older children with reflux may have heartburn, a burning feeling in the chest, or a sour taste in the mouth.
• They might also have bad breath, tooth erosion, or a cough that won't go away.
• If you're worried about an older child, speak with your doctor.

Symptoms in older adults

• In older adults, reflux can cause heartburn, regurgitation, chest pain, or difficulty swallowing.
• This article focuses on babies. If you or a family member is an older adult with these symptoms, please see a healthcare provider.

Causes

Main causes

• The muscle between the food pipe and the stomach is not yet fully developed, so it opens too easily.
• Babies drink mostly liquid, which moves back up easily.
• Babies lie flat for much of the time, making it easier for stomach contents to flow back.
• The food pipe is short, so the stomach contents only have a short distance to travel.

Risk factors

• Being born prematurely
• Having a family history of reflux
• Certain feeding positions, like lying down while feeding
• Overfeeding or feeding too quickly

When to see a doctor

See a doctor urgently if:

• If your baby is not gaining weight or is losing weight
• If your baby is refusing to feed or feeding much less than usual
• If you see blood or bile in the vomit
• If your baby shows signs of dehydration (fewer wet nappies, dry mouth, no tears when crying)

Book a routine appointment if:

• If reflux is causing distress or your baby seems in pain
• If spitting up is getting worse rather than better after 6 months
• If you have concerns about your baby's feeding or growth

Diagnosis

Doctors usually diagnose reflux based on a careful discussion with you about your baby's symptoms, a physical exam, and checking your baby's weight and feeding pattern. In most cases, no special tests are needed.

Tests that may be done

• An ultrasound of the tummy may be done to rule out other causes.
• A pH probe test can measure how much acid comes back up, but this is rare in babies.
• An endoscopy (a thin tube with a camera) might be used in severe cases, but only under specialist advice.

What to expect at your appointment

Your doctor will ask about your baby's feeding routine, how often they bring up milk, and whether they seem uncomfortable. They may also watch you feed your baby and check how your baby is growing. You'll have a chance to ask questions and talk through any worries.

Treatment

For most babies, simple feeding and positioning changes can greatly reduce reflux. Medication is only suggested when reflux is severe or causes problems such as poor weight gain or breathing difficulties. Any treatment should always be discussed with a qualified healthcare provider.

Self-care at home

• Feed your baby smaller amounts, more often.
• Burp your baby gently after feeds to release trapped air.
• Keep your baby upright for 20–30 minutes after feeding.
• Avoid overfeeding and try to feed in a calm, unhurried way.
• If bottle-feeding, check the teat hole is not too big or too small.

Medical treatments

For some babies, a doctor may suggest making feeds thicker, for example with a thickening agent, but this should only be done under professional guidance. Occasionally, medicines that reduce stomach acid or help the stomach empty more quickly are prescribed. These are only used in certain situations, and you should always ask your doctor or pharmacist about any medicine before giving it to your baby.

When is surgery considered?

Surgery is very rarely needed for reflux in babies. It is only considered if reflux is severe, does not improve with other treatments, and is causing serious problems like breathing issues or failure to thrive.

Living with this condition

Living with a reflux baby can be messy and tiring. Keep a burp cloth or muslin square handy, and protect your clothes and furniture with towels or covers. Your baby may feed more slowly, so allow extra time for feeds.

Lifestyle tips

• Keep your baby upright after feeds as much as possible.
• Make sure your baby's nappy is not too tight around the tummy.
• Avoid vigorous play or bouncing your baby right after feeding.
• Keep the home smoke-free, as smoke can make reflux worse.

Diet and exercise

For formula-fed babies, your doctor or health visitor may suggest trying a different formula, but only on professional advice. For breastfed babies, it's fine to continue breastfeeding; sometimes a mother's diet can play a role, but this is not true for every baby. Gentle movement and tummy time when your baby is awake and alert can help with digestion, but not right after a feed.

Mental health and emotional wellbeing

Caring for a baby with reflux can be stressful. You may feel worried, exhausted, or unsure if you're doing things right. These feelings are normal. Talk to your partner, family, or friends, and don't hesitate to ask your health visitor or doctor for help. Looking after your own wellbeing helps you care for your baby.

Prevention

Reflux is not entirely preventable, but some of the things that help manage it — like feeding smaller amounts, burping regularly, and keeping your baby upright after feeds — can also reduce how often it happens.

Complications

If left untreated

• Poor weight gain or weight loss if a baby is bringing up large amounts of milk
• Inflammation of the food pipe (oesophagitis), which can cause pain and feeding difficulties
• Breathing problems and chest infections if milk goes into the lungs

Long-term outlook

The good news is that most babies grow out of reflux by the time they reach 12 months. With simple measures and a little patience, nearly all babies do very well. Even when treatment is needed, it is usually effective, and your healthcare team will support you every step of the way.

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